Experts: Anthrax Attack Could Cost 100,000+ Lives
Mon March 17, 2003 05:30 PM ET
By Alison McCook

NEW YORK (Reuters Health) - A large-scale anthrax attack on a major US city could cause 123,000 deaths, given current levels of preparedness, researchers said Monday.

This figure stems from the findings of a mathematical model, which describes an attack involving one kilogram of anthrax spores released from a height of 328 feet in a city of more than 10 million people.

In this scenario, the investigators predicted that everyone would receive antibiotics at least 48 hours after an attack. Many people would begin to show symptoms of infection within two days after exposure, which would alert officials that an attack had occurred.

The authors also assumed that the spores would be just as easy to inhale as those used in the anthrax attacks of 2001, which involved six letters filled with one to two grams of anthrax spores and caused five deaths.

Study author Dr. Lawrence M. Wein of Stanford University in California told Reuters Health that this estimate is not set in stone.

Certain public health measures--such as more rapid access to medical care and quicker distribution of antibiotics--could dramatically reduce the number of deaths resulting from such an attack, he said.

The purpose of the current estimate is not to frighten, but to help officials devise a plan to reduce casualties in the event of such an attack, Wein noted.

"While we realize we may be creating some fear in the population, we feel that's more than offset by trying to identify the elements of a successful response," Wein explained.

He and his colleagues published the results in the early online edition of the Proceedings of the National Academy of Sciences.

Looking at the impact of certain changes to the public health system on the mathematical model, Wein and his colleagues identified measures that could dramatically reduce the number of deaths after an anthrax attack.

For one, he said that the person with power to respond to an attack--such as the president--needs to act quickly, and not wait for laboratory tests to confirm that anthrax has been released.

Another important measure should involve "distributing antibiotics as quickly as possible," Wein said, and teaching people how best to use them.

Indeed, he and his colleagues found that giving people rapid access to antibiotics that fight anthrax, such as Cipro, would help more than early detection systems or prioritization of medical care based on who needs it most.

Although providing people with anthrax-fighting antibiotics before any attack occurs raises concerns that improper use will increase resistance to the vital drugs, the authors found that distributing the drugs either before an attack or within several hours would cut the number of casualties by half.

In terms of medical care, Wein and his colleagues found that measures that increase the ability of healthcare facilities to respond to a large influx of anthrax patients would go a long way in curbing deaths.

Increasing medical preparedness will involve training more people in how to handle anthrax patients, and organizing so that experts from throughout the country could be mobilized quickly to the site of an attack, Wein said.

Because there have been so few anthrax outbreaks, it remains unclear who would be most likely to die during an anthrax attack of the scale described in the current model, Wein noted.

During a previous outbreak in the former Soviet Union, which killed fewer than 100 people, most of those who died were over 40 years old, the researcher said, suggesting that the elderly might be at especially high risk.

And while people closest to the site where the anthrax is released may be most concerned about their risks, Wein noted that if the spores are released from above--as his model assumes--people most at risk for exposure would be those downwind from the site.

Wein insisted that the model featured in his study represents a realistic depiction of how a terrorist attack involving anthrax might look--in fact, he noted, it could be a lot worse than he describes.

"We're not looking at the most doomsday scenario here," Wein said.

In an accompanying editorial, Dr. G.F. Webb of Vanderbilt University in Nashville agrees that the findings suggest better preparedness is needed.

The current study "compels a conclusion of unquantifiable human suffering that anthrax, as a weapon of mass destruction, may inflict," Webb writes.

SOURCE: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.0636861100.